Provider Demographics
NPI:1104203538
Name:GUPTA, HIMANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:HIMANK
Middle Name:
Last Name:GUPTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FEDERAL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2422
Mailing Address - Country:US
Mailing Address - Phone:203-775-9463
Mailing Address - Fax:203-775-9463
Practice Address - Street 1:304 FEDERAL RD STE 305
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2422
Practice Address - Country:US
Practice Address - Phone:203-775-9463
Practice Address - Fax:203-775-9463
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT134291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics